| Bronx Borough Medical Practice Pc | |
|
2494 Williamsbridge Rd Bronx NY 10469-4806 | |
| (914) 395-3691 | |
| Not Available |
| Full Name | Bronx Borough Medical Practice Pc |
|---|---|
| Speciality | Physical Medicine & Rehabilitation - Pain Medicine |
| Location | 2494 Williamsbridge Rd, Bronx, New York |
| Authorized Official Name and Position | Mack Lee Sullivan (OWNER) |
| Authorized Official Contact | 9143953691 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bronx Borough Medical Practice Pc 369 White Plains Rd Ste B Eastchester NY 10709-2805 Ph: (914) 395-3691 | Bronx Borough Medical Practice Pc 2494 Williamsbridge Rd Bronx NY 10469-4806 Ph: (914) 395-3691 |
| NPI Number | 1124590641 |
|---|---|
| Provider Enumeration Date | 12/21/2018 |
| Last Update Date | 12/21/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124590641 | NPI | - | NPPES |
| 115019 | Other | NY | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RS0010X | Internal Medicine - Sports Medicine | (* (Not Available)) | Secondary |
| 2081P2900X | Physical Medicine & Rehabilitation - Pain Medicine | (* (Not Available)) | Primary |
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